Dehydration from acute diarrhea is one of the leading causes of mortality among infants and young children in developing countries. In the United States, dehydration from diarrhea and vomiting can lead to costly emergency room visits. However, dehydration from diarrhea can be cheaply and successfully managed at home by administering an oral rehydration solution (ORS), typically a glucose-electrolyte solution. This method of treatment is termed oral rehydration therapy (ORT). The World Health Organization (WHO) has suggested the use of an ORS with the composition shown in Table 1. This solution has been shown to treat dehydration from acute diarrhea in several clinical studies and is believed to be a more effective treatment than the previously recommended composition, which contained more salt and sugar.
TABLE 1ORS composition recommended by the WHO.componentmillimoles/literSodium75Chloride65Glucose, anhydrous75Potassium20Citrate10
ORT is often carried out with fluids that do not meet the WHO's recommended composition, despite the data. These alternative beverages, such as sports drinks, other electrolyte solutions, and fruit juice, are typically not formulated for the unique needs of dehydrated patients, and thus may fail to provide effective ORT. Sports drinks, for example, are typically formulated to replace sugar and sodium lost as a result of exercise and sweat, rather than being optimized for dehydration from vomiting. In particular, many sports drinks contain fructose and/or sucrose (which hydrolyzes into fructose and glucose), in addition to glucose, in order to maximize sugar uptake because the absorption of glucose and fructose are independent of each other. Sports drinks are also aimed at replacing electrolytes lost through sweating, which is almost exclusively sodium. Vomiting and diarrhea, however, lead to substantial loss of potassium in addition to sodium and therefore treatment must replace lost potassium. Some oral electrolyte solutions, though marketed for ORT in response to dehydration in children, do not meet the WHO's recommended composition. For example, PEDIALYTE, manufactured by Abbott Laboratories of Chicago, Ill., has a glucose/sodium ratio of 7.4 (instead of the approximately one-to-one ratio of the WHO's recommended composition).
Although these alternative beverages do not provide the therapeutic effects of the WHO's recommended composition, some may be used more often by clinicians and/or patients than the WHO composition because of a taste preference for sweeter, less salty drinks, the convenience and availability of some alternative beverages, and/or the low cost of some alternative beverages. In particular, one of the main difficulties in administering ORSs, particularly in pediatric settings, is that existing ORSs taste very salty. To get children to drink an effective amount of an ORS, the ORS is formulated with extra sugar and other additives to mask the taste of the salt or to lower the electrolyte concentration. However, adding sugar or decreasing the electrolyte concentration may result in less effective rehydration.